Social Media Guidelines by YOU

Ethical Use of Social Media in Urology: Integrating Professional Conduct, Legal Risk, and Digital Responsibility

Background

Social media platforms are increasingly used by both urologists and patients for information exchange, academic interaction, and health awareness. While these platforms offer opportunities for education and professional engagement, they also pose risks related to misinformation, patient confidentiality, and unintended promotion. The ethical obligations of medical professionals and the fiduciary nature of doctor–patient relationships make the use of social media fundamentally different from its use in other professions. There is a need to clearly understand how urologists can participate in the digital space without violating professional or legal boundaries.

Purpose of this White Paper

This document aims to guide Indian urologists on the ethical and responsible use of social media. It aims to frame social media guidelines in accordance with the commandments of Indian regulatory bodies, while aligning them with recommendations from international urological bodies.

Key Findings

● Recent evidence shows that urology-related content on social media, especially YouTube, is widely accessed by patients but often lacks reliability and quality control.

● International urological associations encourage professional and educational use of social media, whereas Indian regulations place stronger emphasis on preventing promotional activity and protecting patient interests.

● There is a regulatory gap between global professional guidance and Indian legal and ethical expectations, leading to confusion among urologists about acceptable online conduct.

● Social media can be a useful educational and academic tool when used within clearly defined ethical boundaries.

Key Recommendations

● Use social media primarily for public education, academic exchange, and professional awareness rather than self-promotion.

● Video content preparation should aim to be of high quality, as assessed using standardized quality assessment tools such as DISCERN, PEMAT, etc.

● Avoid posting patient images, both personal and radiological, or case details on personal public platforms.

● Maintain strict patient confidentiality and refrain from discussing patient-related information on public social media platforms.

● Share only factual, verifiable, and balanced information while avoiding suggestive, provocative, or indecent content. Clickbait and attention-catching thumbnails should be discouraged.

● Refrain from testimonials, endorsements, claims, or visibility-enhancing tactics that may be interpreted as enticing or persuasive.

● Conduct all online interactions with professionalism, recognizing the permanence and public nature of social media content.

INTRODUCTION & BACKGROUND

1. Introduction

Social media is becoming an indispensable part of everyday life across the globe. First introduced as a digital platform for exchanging ideas, thoughts, and information, it has now diversified and evolved to support all aspects of human existence, from maintaining personal or professional digital identity to education, advertising, marketing, news, entertainment, and simply staying relevant (1). As per the latest data, there are about 462 million active social media users in India, which is about one-third of the country’s population (2). Social media is also gaining importance in healthcare, where patients can directly access educational content on the prevention and treatment of various illnesses, expert opinions, become familiar with healthcare services, and contact health professionals after reviewing multiple health facilities in their area (1,3). On the other hand, it allows healthcare providers to disseminate information and education, provide support, raise awareness of their services, and maintain a professional digital presence (1). Urology is an ever-evolving surgical specialty, and social media is increasingly popular as a platform for sharing information, surgical procedures, and patient education quickly. (4). For these reasons, platforms such as YouTube, Instagram, Facebook, and WhatsApp are among the most commonly used social media applications by urologists and patients alike (5).

Rampant use of unannotated patient data has raised concerns about patient privacy, professional behavior, and intent. Urology poses distinct ethical and medicolegal dilemmas owing to the utilization of genital imaging, endoscopic imaging, and genital reconstructive recording, and the discussion of sexual problems, which heightens the possibility of patient identification and privacy breach. Owing to the fiduciary responsibilities of medical professionals, regulations are required to ensure the ethical use of social media, prevent the spread of misinformation, address skewing of patient perceptions due to rigorous advertising campaigns, and protect patient confidentiality in the name of spreading awareness (1).

Even though urologists are using digital tools and social media, there is no formal, systematic, specialty-specific training in India. Given the expanding role of social media in urology, there is a clear need for structured guidelines to ensure its use remains ethical, professional, and aligned with patient welfare and academic integrity (1,4).

This research suggests a useful, legally sound framework for ethical use of social media in urology.

2. Current Scenario

The National Medical Commission (NMC) in India has established a revised legal framework that clearly defines the roles and responsibilities of healthcare professionals when using social media (6). Other legal framworks under which social media activities can fall into scrutiny are the Information Technology act, the Digital Personal Data Protection act and the Consumer Protection act (7,8,9) [Box 1]. Although both the European Association of Urology (EAU) and the American Urological Association (AUA) have issued guidelines on social media use in urology, these recommendations are tailored to their respective regions and do not fully align with regulatory requirements in India (1,10). For example, while the EAU and AUA allow limited educational and professional promotion under strict conditions, the NMC’s ethical framework expressly prohibits promotional activities by individual practitioners. This regulatory divergence highlights the need for context-specific guidance to ensure social media use by Indian urologists remains both compliant and professionally appropriate.

Box 1: The legal system in India pertaining to digital practices for healthcare professionals

1. Regulations from the National Medical Commission (2023):Unprofessional behavior includes breaking confidentiality and unethical advertising, which can lead to disciplinary action like suspension or deregistration (6).

2. The Information Technology Act, 2000, punishes violations of privacy, while Sections 67 and 67A deal with publishing obscene or sexually explicit content, with jail time and fines (7).

3. The Digital Personal Data Protection Act, 2023, allows for large fines, up to ₹250 crore, for not putting in place reasonable safeguards (8).

4. Consumer Protection Act, 2019: Under the law, misleading ads can lead to penalties and even jail time. A single post on social media can lead to professional, civil, and criminal liability (9).

3. Objective of this White Paper

● To review the current evidence on social media use in urology

● To outline ethical principles for social media use by Indian urologists in accordance with National Medical Commission (NMC) regulations

● To clarify which forms of online activity are appropriate and which may be viewed as promotional or professionally inappropriate in India

● To offer a practical approach for maintaining an educational, responsible, and compliant digital presence while protecting patient confidentiality and public trust

CURRENT EVIDENCE & CLINICAL DISCUSSION

Overview of Current Evidence

The synthesis of current evidence for this white paper has been done in two parts- first on the existing evidence on social media use in urology, and second on its ethical considerations, with a focus on national and international legal and societal recommendations.

A literature search was performed across PubMed/MEDLINE, Embase, Scopus, and Web of Science for studies published between January 2016 and 8 April 2026. For the first part, a search string involving terminologies for major social media platforms was synthesised, including: ( “Social Media”[MeSH] OR (social media) OR (SoMe) OR (twitter) OR “X (formerly Twitter)” OR (instagram) OR (youtube) OR (facebook) OR (whatsapp) OR (telegram) OR (tiktok) OR (reddit) OR (blog* ) OR (microblog*) AND ( “Urology”[MeSH] OR urolog* OR endourolog* OR uro-oncolog* OR androlog* OR “stone surgery” OR “prostate cancer” OR “robotic prostatectomy” OR “urin* infection” OR “uti” OR “incontinence” )

Figure 1 highlights the search strategy used for this white paper.

Social Media for Urologist Search Strategy — Screenshot

The included studies were broadly divided into the following categories (Table 1):

S.no.	Category of study	Number of studies
1	YouTube videos for patients/urologists-quality assessment	61
2	Twitter for patient education	14
3	Instagram for patient education	3
4	Social media for residency matching (US)	8
5	WhatsApp for sharing patient data	2
6	Social media for conducting research study recruitment, etc)	6
7	TikTok for patient education	10
8	Twitter/X for urology conferences	13
9	Another apps-Facebook, Reddit, Pinterest	6

Table 1: Categories of included studies

As per our literature search, YouTube is the biggest social media platform containing the maximum content related to urological conditions, shared by urologists, medical institutes, allied health professionals, patients, and people from other professions/content creators. Most of these studies, especially those on YouTube videos, were cross-sectional quality assessments of content on that platform using standardized tools such as DISCERN, JAMA, PEMAT, etc. (Table 2).

Tool	Full Form / Origin	Key Domains / Elements Assessed	Scoring System	Interpretation	Relevance to Urology / Surgical Videos
DISCERN(11)	Developed by the University of Oxford for patient information quality	● Clarity of aims ● Reliability of sources ● Bias/balance ● Description of treatment options ● Risks & benefits -● Support for shared decision-making	16 questions (1–5 each). Total: 16–80	16–26: Very poor; 27–38: Poor; 39–50: Fair; 51–62: Good; 63–80: Excellent	Useful for patient education videos in urology (e.g., ED, LUTS, prostate disease)
JAMA Benchmark Criteria(12)	Journal of the American Medical Association	● Authorship (credentials)● Attribution (references)● Disclosure (conflicts)● Currency (date/update)	0–4 (1 point each)	Higher score = better transparency & credibility	Assesses credibility and accountability, not depth of content
PEMAT(13)	Patient Education Materials Assessment Tool (AHRQ)	● Understandability: – Content clarity● Word choice ● Layout/visuals Actionability:Clear actions for users	Percentage score (0–100%)	≥70% generally considered adequate	Important for patient comprehension, especially for counselling videos
LAP-VEGaS(14)	Laparoscopic surgery Video Educational Guidelines	● Case presentation (indication, patient details) ● Preoperative workup ● Step-by-step procedure ● Anatomy identification ● Instrumentation ● Intraoperative findings ● Complications & management● Outcomes ● Audio/visual clarity	Checklist-based (yes/no or scored items)	No universal cutoff; higher adherence = better educational value	Gold standard for surgical videos (laparoscopy, endourology, robotics)

Table 2: Quality assessment tools for medical education videos on YouTube.

Out of the selected studies, only three were randomized controlled trials (RCTs): one comparing social media and search engines for patient recruitment in a study, a second one comparing social media vs standard preoperative and postoperative counselling in pediatric urology cases, and a third one comparing awareness through social media vs search engine(15–17).

The second part of evidence synthesis was done regarding ethics of social media use in urology. A literature search was performed after adding keywords like ethic* OR professionalism OR consent OR private OR confidentiality. Out of the 54 results in past 10 years, nine studies were selected for review (1,3,4,18–23). These included articles on social media ethics in urology and societal guidelines on the same. The NMC guidelines for Registered medical practitioners (RMPs) were also retrieved. The following table enlists commandments issued by NMC and General principles on social media use issued by EAU and AUA.

S.no.	Commandments by National Medical Commission (NMC), India on use of social media by healthcare professionals (6)	European Association of Urology (EAU) guidelines on use of social media by urologists (1)	American Urological Association’s (AUA) list of best practices on social media (23)
1	RMPs can provide information and announcements on social media. However, the information should be factual and can be verified. The information should not be misleading or deceptive, nor should it exploit the patient’s vulnerability or lack of knowledge	Never undermining patient privacy and confidentiality is the first guideline, highlighting that violations of privacy are potentially the most serious infraction of professional SoMe use.	Being Professional, and identifying with the AUA Code of Ethics.
2	RMPs should avoid discussing the treatment of patients on public social media or prescribing medicine to patients on public social media platforms. If a patient approaches doctors through public social media, the doctor should guide the patient toward a telemedicine consultation or in-person consultation as the situation warrants.	Understanding how other users behave online before interacting on SoMe, to learn the etiquette of each platform prior to engaging actively.	Protecting Confidentiality, similar to the BJUI and EAU recommendations, is a key practice to remind SoMe users never to disclose protected health information or other patient identifiers.
3	RMPs should not post patients’ photographs or scan images (CT/PET scans) on social media. Once an image is posted in social media, it becomes data that is owned by the social media company or the general public.	Stating your name, who you are, and your profession is key in establishing a professional digital identity that is in line with your professional goals.	Allowing for Interaction supports constructive debate and conversations while maintaining respect for others.
4	RMPs’ behavior on social media towards their colleagues should be guided by general principles of medical ethics on professional behaviors.	Avoid providing medical advice and maintain limits between your SoMe presence and patients to ensure professional decorum is maintained.	Being Courteous is suggested to avoid threatening remarks or personal insults.
5	RMPs should not directly or indirectly indulge in the practice of purchasing “likes”, “followers”, or paying money so that search algorithms lead to their name being listed at the top or registering on software programs (apps) that charge fees for higher ratings or soliciting patients.	Assuming permanence is recommended, as all content online can usually be found in some public manner despite deletion. A ‘pause before you post’ rule has emerged in many recommendations to remind users to take a moment to remember the time-stamped permanence of all SoMe interactions.	Exercising Discretion when posting is suggested to beware of copyright and plagiarism online.
6	RMPs should not request or share patients’ testimonials or recommendations or endorsements or reviews on social media.	Using instant messaging software with care, as not all messaging applications are HIPAA compliant, especially in the United States. They recommend that users educate themselves on their institutional policies and ensure the messaging service has appropriate encryption with associated messaging de-identification.	Supporting the AUA Identity similarly encourages online users to engage in ways that reflect the identity of the AUA.
7	RMPs should refrain from sharing images of healed/cured patients, or surgery/procedure videos or images displaying impressive results under any circumstances.	Being courteous and avoiding defamatory comments is recommended and key to exercising professionalism in all SoMe conduct.	Similar to the BJUI and EAU, the AUA recommends Being Thoughtful, to suggest that posted information is permanent.
8	RMP is allowed to share educational material for the information of the general public. However, communication should be limited to the expertise of the RMP.	Beware of SoMe policies set by employers to ensure compliance. Stating all views are your own on your SoMe profiles can be helpful in this regard.
9	RMP’s webpage should also follow the same guidelines as above.	Beware of how advertising and self-promotion are perceived by others as a reminder that your professional obligations are to report factually correct opinions and avoid unsubstantiated claims.
10	On social media, RMPs should refrain from boundary crossings or violations and conduct themselves with dignity and decorum.	Use disease-specific ontology hashtags for structured online communication. In 2016, Kutikov et al. produced a comprehensive list of hashtags and Twitter handles to facilitate urology-specific conversations online
11	Soliciting patients directly or indirectly through social media is unethical.

Table 3: Commandments and Recommendations on Social Media Use by healthcare professionals/Urologists by NMC, EAU and AUA.

NMC guidelines, as listed above, are regulatory in nature, and disciplinary action is expected on complaint. Whereas EAU and AUA advise on professional conduct and self-discipline. Therefore, their recommendations cannot be directly applied in the Indian scenario.

Gaps in Current Practice

Unlike many other professions, healthcare professionals are ethically prohibited from marketing their services on social media due to their fiduciary duties as healthcare providers (1). Practicing medicine rests on trust and a duty to place patients’ interests first. Promotional advertising can disrupt this balance by influencing vulnerable individuals, exploiting knowledge gaps, and creating the impression that care is driven by visibility rather than appropriateness (23). For urologists, the appropriate approach is social media education, as conventional marketing practices are neither applicable nor ethically appropriate in medical practice. A review of current evidence highlighted the varied uses of social media, from urology training to conducting and disseminating research. These domains remain underexplored, primarily due to a lack of social media awareness and training amongst urologists. For example, very few urologists and academic institutions have Twitter or X accounts, and most are unaware of the recommended hashtags for urological conditions (5). When used responsibly within the prevailing legal and ethical framework, social media can help urologists build professional recognition through education, academic engagement, and public awareness rather than promotion.

The rapid expansion of social media has significantly transformed the dissemination of health information, particularly in urology. Social media serves diverse purposes for both patients and healthcare professionals. Wang et al. noted that laypersons frequently use these platforms to share personal experiences and gain information about urological conditions, whereas healthcare professionals utilise them for education, networking, and career development (24). Among various platforms, YouTube has emerged as the largest repository of patient-oriented medical content, including videos related to urological conditions and surgical procedures. However, concerns regarding the accuracy, reliability, and quality of such content remain substantial. Several validated tools, as described in Table 2, have been utilized to assess the quality of online health information. Across multiple studies, the majority of YouTube videos related to urological conditions have consistently demonstrated poor quality scores when evaluated using these tools. The source of uploaded content plays a critical role in determining its reliability. Baydill et al., in their analysis of videos on Peyronie’s disease, found a substantial proportion of misleading or biased information, with many videos functioning as medical advertisements. Notably, a significant percentage of content was uploaded by non-medical individuals or patients (25). Furthermore, videos depicting investigational or non-recommended procedures, such as penile augmentation, often garnered higher view counts, raising concerns about their potential to misinform patients (26). These findings underscore the importance of authoritative and authentic sources in improving content quality. Although the overall quality remains suboptimal, certain exceptions have been reported. Content related to Kegel exercises and pelvic floor muscle training following prostatectomy has demonstrated relatively higher quality scores in some studies (27).

Other platforms have also been evaluated for their role in disseminating urological information. Augustyn et al. found that 34% of urology-related videos on TikTok contained misinformation, emphasizing the risks posed by unregulated, short-form content. Analyses of kidney stone prevention–related videos on TikTok demonstrated that only a small fraction of content is generated by physicians; however, these videos tend to have significantly higher quality scores (p < 0.05), again emphasising the importance of expert involvement (28).

Twitter (now X) has been widely used for academic dissemination, particularly during conferences, for recruiting research participants, for residency matching, and for enhancing research visibility and citation metrics. Hayon et al. demonstrated that urological publications promoted on Twitter experienced a two- to three-fold increase in citation rates (p < 0.01) (29).

Despite these advantages, the literature consistently highlights significant concerns about the lack of regulation, standardization, and quality control of online medical content. While it is necessary that most medical information content comes from qualified professionals in that field, mere qualification does not guarantee reliable, accurate social media content on medical education. Cheng et al. conducted an integrated analysis across platforms including Facebook, Reddit, Twitter, and Pinterest, revealing that 32% of posts cited no scientific evidence, and none reported level 1 evidence (30). Studies have highlighted poor adherence to established guidelines, such as those of the European Association of Urology (EAU), in social media content related to urological conditions (4). Koo et al. reported that 43% of Facebook accounts belonging to urologists contained unprofessional or explicit material, including profanity and language that could be perceived as offensive toward patients, raising ethical and professional concerns about online conduct (10). This absence of academic rigor, coupled with elements of promotional bias, was shown to diminish the overall educational value. Corsi N et al. evaluated the top 100 urology influencers on Twitter. They identified only a weak correlation between social media influence rank and academic impact as measured by the H-index (p = 0.02), suggesting that online popularity does not necessarily reflect scholarly credibility (31).

Overall, while digital platforms offer significant potential for patient education, professional engagement, and research dissemination in urology, the predominance of low-quality, potentially misleading content requires greater involvement from healthcare professionals, the development of standardized evaluation frameworks, and the implementation of regulatory strategies to ensure information reliability.

RECOMMENDATIONS / PROPOSED CLINICAL APPROACH

A. The recommendations for Indian Urologists are being proposed on the basis of the following Core Ethical Principles:

1. Confidentiality: Patient identity must not be disclosed without a clear, informed, and written agreement.

2. Professionalism: Social media posts and activities must follow the rules of medical practice.

3. Scientific Integrity: The information should be based on facts and not be misleading.

4. Limits: Social media should not be used for patient consultations.

5. Transparency: Any conflicts of interest must be made clear

6. Ethical Promotion: Avoid claims that are false or cannot be proven.

B. A urologist shall be careful in the following potentially dangerous domains while posting on social media:

1. Imaging of the genitals and andrology-specific images.

2. Videos taken during surgery (PCNL, RIRS, etc.) with patient identity exposed

3. Documentation of outcomes before and after treatment for sensational claims/promotion of technique/hospital/clinic/clinician

4. Patient testimonials for marketing

5. Uncommon reconstructive cases with discernible characteristics which may expose the identity.

Few examples of the legal implications of posting urology-specific videos are enumerated in Box 2.

Box 2. Examples of Indian Cases of Social Media Misconduct in Urology

Scenario	Violation	Potential Consequence	Applicable Law
OT video (PCNL/RIRS) posted without consent	Breach of confidentiality	Disciplinary action, takedown	NMC (6); IT Act (7)
Genital image sharing (Peyronie’s/ED)	Privacy violation / explicit content	Criminal liability	IT Act (7)
“100% success” promotional claims	Misleading advertisement	Fine ± imprisonment	Consumer Act(9)
Patient testimonial videos	Unethical solicitation	Professional action	NMC(6)
Rare reconstructive case posted	Indirect identification	Ethical/legal scrutiny	NMC(6); DPDP(8)

C. A Risk Stratification Model (Figure 2) has been developed to categorise type of data shared through social media and potential medicolegal implications arising from sharing them.

Figure 2: Risk stratification for social media related legal consequences for urologists

Low Risk: Educational materials and rules

Moderate Risk: Cases that have been de-identified with permission

High Risk: Videos of surgeries and content about complications

Very High Risk: Pictures of genitals, testimonials, and claims made in ads

Extreme Risk: Patient data that can be linked to a specific person without their permission

Risk goes up when anything is identifiable, sensitive, or meant to be promoted.

D. The following Commandments are proposed on social media ethics in urology:

1. Use social media primarily for education, not self-promotion. Share disease awareness, preventive advice, and general urological information within one’s domain of expertise, avoiding any content that could be interpreted as showcasing personal surgical skill or as a way to attract patients.

2. Do not post patient images, scans, or surgical videos on personal public platforms. Even with consent, such posts may violate NMC expectations; reserve clinical media for academic forums, conferences, or institutional teaching platforms, after obtaining the desired permission from regulatory authorities, if applicable.

3. Ensure high quality of shared educational social media content as per quality assessment tools. Video content preparation should aim to be of high quality, as assessed using standardized quality assessment tools such as DISCERN, PEMAT, etc. Online content should be backed by evidence citations wherever possible, and content preparation in accordance with Level 1 evidence should be encouraged.

4. Maintain strict patient confidentiality and professional boundaries. Avoid discussing individual cases or responding to patient-specific queries publicly

5. Avoid testimonials, ratings, follower inflation, or visibility-enhancing tactics. Refrain from soliciting reviews or endorsements, and avoid using paid tools that increase digital prominence.

6. Avoid sensationalism of urology-related content. . Ensure posts prioritize patient dignity, scientific accuracy, and public health education rather than creating visually appealing content to gain likes, followers, or patient interest. Special attention should be given to sexual wellness and andrology topics, and a clinical, evidence-based educational tone should be maintained. Avoid provocative visuals, exaggerated claims, clickbait, or suggestive language designed to attract attention.

7. Ensure all shared information is factual, verifiable, and non-misleading. Present balanced, evidence-based content without claims of superiority, outcomes, or expertise that could influence patient choice.

8. Maintain professional conduct and decorum in all online interactions. Engage respectfully with colleagues and the public, recognising that social media activity reflects on professional integrity and may be permanently visible.

9. Encourage social media use for academic research, residency training, and updating conference highlights.

10. Always keep in mind a safeguard checklist before posting anything on social media ( Box 3).

● Is the patient or clinical data unidentifiable?
● Is explicit, written consent obtained?
● Is the content evidence-based and accurate?
● Is it in line with the legal and professional standards?
● Is the intent educational rather than self-promotional?If the answer is “No,” don’t post.

Box 3: Practical safeguard checklist for urologists before posting on social media.

Future Directions

There is a need to develop national specialty-specific norms for social media use in urology, including guidance for responsible use of AI-generated medical content. Incorporating digital ethics and social media professionalism into urology education and training can help clinicians navigate these evolving platforms safely and responsibly.

Limitations

Digital platforms, AI technologies, and the associated legal and regulatory frameworks are evolving rapidly, making it difficult to establish recommendations that remain universally applicable. In addition, specialty-specific empirical evidence on social media ethics in urology remains limited, highlighting the need for further research in this area.

Conclusion

Social media has become an influential medium for communication, learning, and public engagement in modern urological practice. However, for Indian urologists, its use must be carefully aligned with the ethical and legal framework laid down by the NMC. This white paper highlights the need to clearly distinguish between social media education and promotional activity, ensuring that the digital presence remains centered on patient awareness, academic exchange, and professional integrity. By adhering to principled, evidence-based, and regulation-compliant practices, urologists can participate meaningfully in the digital space while safeguarding patient confidentiality, public trust, and the dignity of the profession.

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